Chronic Low Back Pain

Overview

Chronic low back pain is pain in the lower part of the back that persists for 12 weeks or longer. It is one of the most common reasons people see a doctor and a leading cause of missed work and reduced activity. Unlike short-lived (acute) back pain that usually settles within a few weeks, chronic pain can continue even after the original strain or injury has healed.

For many people no single, serious cause is found, and the pain comes from a combination of the spine's joints, discs, muscles, and nerves, along with the way the body and brain process pain over time. The good news is that most chronic low back pain can be improved with active treatment, even when a precise cause is not identified.

Symptoms

Symptoms vary from a dull, constant ache to sharper pain, and they may come and go.

• Ongoing ache or stiffness across the lower back
• Pain that worsens with prolonged sitting, standing, bending, or lifting
• Stiffness that is often worse in the morning or after rest
• Pain that sometimes spreads into the buttock or down the leg
• Reduced flexibility and difficulty with everyday movements

Certain symptoms are warning signs ("red flags") that need prompt medical attention: new weakness or numbness in the legs, loss of bladder or bowel control, numbness around the groin, fever with back pain, or pain after a significant injury.

Causes

Chronic low back pain often has more than one contributing cause:

• Disc problems: A worn or bulging disc, such as in degenerative disc disease or a herniated disc.
• Joint and ligament wear: Arthritis of the spine's small joints, sometimes called osteoarthritis of the spine.
• Muscle and soft-tissue strain: Repeated strain or deconditioned core muscles.
• Nerve irritation: Pressure on a nerve can cause pain spreading down the leg, as in sciatica.
• Pelvic joint problems: Issues with the sacroiliac joint, such as sacroiliac dysfunction.

Risk Factors

• Older age and natural wear of the spine
• Being overweight, which adds load to the lower back
• Physically demanding work or repeated heavy lifting
• A sedentary lifestyle and weak core muscles
• Smoking
• Previous episodes of back pain, and conditions such as depression or anxiety that can affect pain

Diagnosis

Diagnosis starts with a careful history and physical examination. Imaging is not always needed and is reserved for specific situations.

• Medical history and exam: The doctor checks movement, strength, reflexes, and looks for red-flag symptoms.
• Imaging when indicated: X-rays, MRI, or CT scans are used when there are warning signs, a possible specific cause, or pain that does not improve with treatment.
• Other tests: Blood tests may be done if infection or inflammation is suspected.

Many people do not need a scan, because routine imaging often shows changes that are common with age and not the source of pain.

Treatment

Treatment focuses on staying active, reducing pain, and improving function rather than waiting for the pain to disappear completely.

• Exercise and physical therapy: The cornerstone of care, including stretching, strengthening, and gradually returning to activity.
• Staying active: Prolonged bed rest tends to make chronic back pain worse, so keeping moving is encouraged.
• Pain relief: Over-the-counter pain relievers, heat or cold, and other measures as advised; stronger medicines are used cautiously.
• Mind-body approaches: Techniques such as cognitive behavioral therapy and relaxation can help with persistent pain.
• Procedures or surgery: Injections or surgery are considered only for specific causes that do not respond to other treatment.

Prevention

• Stay physically active and build core and back strength
• Maintain a healthy weight
• Use safe lifting techniques, bending the knees and keeping loads close to the body
• Set up a supportive seating and work position, and take breaks from sitting
• Avoid smoking and address stress, which can affect pain

When to See a Doctor

See a doctor for back pain that lasts beyond a few weeks or keeps returning. Seek urgent or emergency care if you have:

• New weakness, numbness, or tingling in one or both legs
• Loss of bladder or bowel control, or numbness around the groin or buttocks
• Fever along with back pain
• Severe pain after a fall or accident
• Unexplained weight loss with back pain

These red-flag symptoms can signal a serious problem affecting the nerves or spine and need prompt evaluation.

Related Topics

Frequently Asked Questions

References

1. National Institute of Neurological Disorders and Stroke (NINDS). Low Back Pain Fact Sheet.
2. Mayo Clinic. Back pain — Symptoms and causes.
3. MedlinePlus, U.S. National Library of Medicine. Low back pain — chronic.
4. American College of Physicians. Noninvasive treatments for low back pain.